1. NCD Situation in Dominica
WHO-IUMSP International Seminar on the Public Health Aspects of NCDs
Lausanne, Switzerland,
August 2010
Helen Royer
NCD Focal Point,
Ministry of Health
Dominica

2. Outline Introduction Situational Analysis Response What is done
Successes
Challenges
The way forward

4. Introduction
The Commonwealth of Dominica, the largest and most northerly of the Windward Islands
Population-74000
Covers an area 790 square kilometres.
Parliamentary type democracy.
The ethnic groups comprise Afro-Caribbean, European, Indians, and the emerging Chinese population

5. Cont/d
The indigenous population, the Carib Indians, (4,500 persons), are mainly concentrated on a reservation of 15.3 sq km.
Their economic activity is mixed consisting mainly of subsistence farming, craft production and boat building

6. Organization of Health System
52 Health Centres
2 ‘cottage’ Hospitals
1 Secondary Care Hospital

7. Situational Analysis
Chronic non-communicable diseases collectively have become major public health threat for persons of all ages.
The increase of life expectancy and of obesity coupled with changing lifestyle practices contribute to a dramatic change in morbidity and mortality profile of CNCDs.
Cardiovascular disease including Hypertension, Cancer, Cerebro-vascular disease/stroke, Diabetes Mellitus, Asthma, and Sickle Cell Disease all make up the listing of the main causes of morbidity, disabilities and mortality in Dominica

8. Cont/d
Population trend indicates increasing numbers of older person as well as an increasing proportion of the population that is in the older age group.
NCDs increases with age hence the likelihood of increased burden on an already strained health care and social systems to address these issues in the future

9. Mortality Data

10. Leading Causes of Death Per 100,000 Population - Both Genders 1991-1995,1996-2000,2001-2005

11. Leading Causes of Death Per 100,000 Population - Male ,1991-1995,1996-2000,2001-2005

12. All Age Groupings, All Sexes, 2005-2009

13. All Age Groupings, Female, 2005-2009

14. All Age Groupings, Male, 2005-2009

15. Response STEPS Survey - Dominica
CNCD Advisory Committee and Partners Meeting – March 08, 2007

16. Cont/d
Tremendous in-country interest following Regional Heads of Government Summit (Sep ‘07)

17. Prime Minister launching National Summit on CNCD,s (Nov ’07

18. What has been done
Several other initiatives targeting the reduction of Non Communicable Diseases.
School health and family life education
Implementation of programme to improve screening techniques for cervical cancer
Primary management clinics for CNCDs
NCD Behavioral Risk Factor Survey.

19. Cont/d Global Tobacco Youth Survey-2007
Global School Health Survey-2008
Annual CNCD Report to PAHO/CAREC begun 2009

20. Cont/d A food and Nutrition situation of the island conducted in 2005.
Priority areas were identified
Dietary Guidelines was launched by Prime Minister on July 9th  

21. Cont/d
Posters, flyers, bookmarks, mugs, T shirts.   Guidelines were widely circulated: Schools, churches, groups, business places, Government departments, service clubs and NGO's   Currently, guidelines are used by health officers for nutrition and health education and requests for guidelines are made constantly by groups and individuals.

22. Cont’d Health awareness programs
Special clinics for hypertensive/diabetic/cancer
Several training workshops for health personnel
Employee wellness program initiated for public servants in April 2010

23. Successes Health promotion (Successful IEC programs
Healthy Eating Campaigns
National-wide physical activity programs
Well structured PHC system
NCD policy formulation
Multi-sectoral collaboration

24. Theme Days observed :Fighting NCD,S

25. School Campaign World No Tobacco Day Against Cancer

26. No Tobacco Campaign for Kids

27. MASS HEAD FOR ADVERTISEMENT

28. Assessment of Response to POS
NCD Capacity /
POS CNCD Summit mandates
Dominica
National Focal Point √
CNCD Plan
National CNCD summit convened
Inter-sectoral CNCD Commission
Appointed and functional
CNCD Communications plan
FCTC ratified
Tobacco taxes >50% sale price X
Smoke free indoor public places - government, health, education

29. Assessment of Response to POS
Advertising, promotion and sponsorship bans X
Financial resources dedicated to CNCD prevention and control
Workplace wellness initiatives
Healthy schools programmes
National food based policy nutrition policy
CWD multi-sectoral, multi-focal celebrations √
Ongoing, mass physical activity or new public PA spaces

30. Assessment of Response to POS
Surveillance: - STEPS or equivalent survey √
- Minimum Data Set
- Global Youth Tobacco Survey
- Global School Health Survey
Chronic Care Model / CNCD treatment protocols
QOC CVD or diabetes demonstration project X

31. The way forward Develop CNCD Strategic Plan
Development of structured NCD program
Effective monitoring and surveillance of NCD,s
 Integrated Programmes especially in Schools, Workplaces and Faith-Based Settings
Development of school health policy
Implementation of FCTC

32. Cont/d Cancer registries development
Strengthening institutional capacity
Salt reduction project
Men's health clinics
Employee Wellness Program strengthened

33. Acknowledgements
I would like to thank the following persons for their contributions.
Dr Paul Ricketts –National Epidemiologist
Mrs Anthelia James- Health Educator
Mrs Titre-Nutritionist
Mrs Marva Smith- Health Statician

34. THANK YOU!